Tahlan Anita, Nanda Annu, Mohan Harsh
Department of Pathology, Government Medical College and Hospital, Chandigarh, India.
Int J Gynecol Pathol. 2006 Oct;25(4):361-5. doi: 10.1097/01.pgp.0000209570.08716.b3.
The aim of this study is to highlight the importance of diagnosing uterine adenomyoma and help in differentiating it from other sinister lesions. Adenomyoma of the uterus is a circumscribed nodular aggregate of benign endometrial glands surrounded by endometrial stroma with leiomyomatous smooth muscle bordering the endometrial stromal component. It may be located within the myometrium, or it may involve or originate in the endometrium and grow as a polyp. A retrospective analysis of 26 consecutive cases of uterine adenomyomas diagnosed in the Department of Pathology, Government Medical College, Chandigarh from January 1994 to December 2004 was done, and their clinical and histological features were analyzed. The criterion used for case identification was a circumscribed mass composed of benign endometrial glands with a stromal component consisting of endometrial type stroma surrounded by leiomyomatous smooth muscle. Mitotic figures were counted within 50 high-power fields (hpf) and recorded as the highest number per 10 hpf. The age of the patients ranged from 22 to 60 years (mean age, 41 years). The most common presenting symptom was abnormal vaginal bleeding (n = 15). Thirteen patients underwent panhysterectomy; 7, total hysterectomy; 1, subtotal hysterectomy; 4, polypectomy or tumor removal; and 1, curettage. Of the 26 cases of adenomyoma, 24 were in the corpus, 1 was in the cervix, and 1 was in the broad ligament. An associated leiomyoma was noted in 12 cases (46.9%). The adenomyomas were firm in consistency and, on cut section, showed a gray-white surface. Five tumors showed cystic spaces filled with dark brown material. On microscopic examination, the tumors were well demarcated from the surrounding structures. The endometrial glands were mostly tubular and showed relatively regular spacing from each other without any back-to-back arrangement. The glands were lined by benign proliferative pseudostratified columnar epithelium. An occasional typical mitotic figure was noted in these glands in a few cases. The glands were surrounded by endometrial stroma which was compact and spindly. This stroma was, in turn, bordered by leiomyomatous smooth muscle. Thick-walled blood vessels were commonly observed. One to two typical mitotic figures per 10 hpf were noted in the endometrial stroma in few cases; however, no mitosis was noted in the myometrial component. Associated adenomyosis was also noted in 8 cases (30.8%). Adenomyomas have to be distinguished from a number of other lesions, for example, adenomyosis, leiomyoma with entrapped glands, atypical polypoid adenomyoma, endometrial polyps, adenofibroma, and adenosarcoma. This study highlights the importance of correctly identifying this fairly common entity and helps to distinguish adenomyoma from other similar appearing benign and malignant lesions.
本研究的目的是强调诊断子宫腺肌瘤的重要性，并有助于将其与其他恶性病变区分开来。子宫腺肌瘤是由良性子宫内膜腺体构成的局限性结节状聚集体，周围是子宫内膜间质，平滑肌瘤样平滑肌与子宫内膜间质成分相邻。它可能位于肌层内，也可能累及或起源于子宫内膜并呈息肉样生长。对1994年1月至2004年12月在昌迪加尔政府医学院病理科确诊的26例子宫腺肌瘤连续病例进行了回顾性分析，并对其临床和组织学特征进行了分析。病例识别的标准是一个由良性子宫内膜腺体组成的局限性肿块，其间质成分由子宫内膜样间质组成，周围是平滑肌瘤样平滑肌。在50个高倍视野（hpf）内计数有丝分裂象，并记录每10 hpf的最高数量。患者年龄范围为22至60岁（平均年龄41岁）。最常见的症状是异常阴道出血（n = 15）。13例患者接受了全子宫切除术；7例接受了子宫全切术；1例接受了次全子宫切除术；4例接受了息肉切除术或肿瘤切除术；1例接受了刮宫术。在26例腺肌瘤病例中，24例位于子宫体，1例位于宫颈，1例位于阔韧带。12例（46.9%）发现合并平滑肌瘤。腺肌瘤质地坚硬，切面呈灰白色。5个肿瘤有充满深褐色物质的囊腔。显微镜检查显示，肿瘤与周围结构界限清楚。子宫内膜腺体大多呈管状，彼此间距相对规则，无背靠背排列。腺体由良性增殖性假复层柱状上皮衬里。少数病例在这些腺体中偶尔可见典型的有丝分裂象。腺体被致密、梭形的子宫内膜间质包围。反过来，这种间质又与平滑肌瘤样平滑肌相邻。常见厚壁血管。少数病例在子宫内膜间质中每10 hpf可见1至2个典型的有丝分裂象；然而，在肌层成分中未发现有丝分裂象。8例（30.8%）还发现合并子宫腺肌病。子宫腺肌瘤必须与许多其他病变相鉴别，例如子宫腺肌病、伴有 entrapped 腺体的平滑肌瘤、非典型息肉状腺肌瘤、子宫内膜息肉、腺纤维瘤和腺肉瘤。本研究强调了正确识别这一相当常见的实体的重要性，并有助于将腺肌瘤与其他外观相似的良性和恶性病变区分开来。
